<div class="my-account signupform">
    <div class="page-title">
        <h1>Edit Address</h1>
    </div>
    <?php
    echo $form->open();
    echo $form->renderGlobalErrors();
    ?>
    <div class="fieldset">
        <h2 class="legend">Contact Information</h2>
        <ul class="form-list">
            <li class="fields">
                <div class="customer-name">
                    <div style="width:70%; float: left;">
                        <label>Title</label>
                        <input type="radio" checked="checked" id="profile_form_title_Mr" value="Mr" name="profile_form[title]">
                        <label >Mr.</label>
                        <input type="radio" id="profile_form_title_Mss" value="Mss" name="profile_form[title]">
                        <label >Mrs.</label>
                    </div>
                    <div class="field name-firstname">
                        <label for="firstname" class="required"><em>*</em>First Name</label>
                        <div class="input-box">
                            <?php
                            echo $form['first_name']->renderError();
                            echo $form['first_name']->render(array('class'=>'input-text required-entry'))?>
                        </div>
                    </div>
                    <div class="field name-lastname">
                        <label for="lastname" class="required"><em>*</em>Last Name</label>
                        <div class="input-box">
                            <?php
                            echo $form['last_name']->renderError();
                            echo $form['last_name']->render(array('class'=>'input-text required-entry'))?>
                        </div>
                    </div>
                    <div class="field name-lastname">
                        <label for="lastname" class="required"><em>*</em>Nick Name</label>
                        <div class="input-box">
                            <?php
                            echo $form['nick_name']->renderError();
                            echo $form['nick_name']->render(array('class'=>'input-text required-entry'))?>
                        </div>
                    </div>
                </div>
            </li>
            <li class="wide">
                <label for="company">Company</label>
                <div class="input-box">
                    <?php
                    echo $form['company']->renderError();
                    echo $form['company']->render(array('class'=>'input-text'))?>

                </div>
            </li>
            <li class="fields address_change">
                <div class="field">
                    <label for="telephone" class="required"><em>*</em>Telephone</label>
                    <div class="input-box">
                        <?php
                        echo $form['phone_no']->renderError();
                        echo $form['phone_no']->render(array('class'=>'input-text required-entry'))?>

                    </div>
                </div>
                <div class="field">
                    <label for="fax">Fax</label>
                    <div class="input-box">
                        <?php
                        echo $form['fax']->renderError();
                        echo $form['fax']->render(array('class'=>'input-text'))?>
                    </div>
                </div>
            </li>
        </ul>
    </div>
    <div class="fieldset">
        <h2 class="legend">Address</h2>
        <ul class="form-list">
            <li class="wide">
                <label for="street_1" class="required"><em>*</em>Street Address</label>
                <div class="input-box">
                    <?php
                    echo $form['street_address1']->renderError();
                    echo $form['street_address1']->render(array('class'=>'input-text required-entry'))?>
                </div>
            </li>
            <li class="wide">
                <div class="input-box">
                    <?php
                    echo $form['street_address2']->renderError();
                    echo $form['street_address2']->render(array('class'=>'input-text'))?>
                </div>
            </li>
            <li class="fields address_change">
                <div class="field">
                    <label for="city" class="required"><em>*</em>City</label>
                    <div class="input-box">
                        <?php
                        echo $form['city']->renderError();
                        echo $form['city']->render(array('class'=>'input-text required-entry'))?>
                    </div>
                </div>
                <div class="field">
                    <label id="" for="zip" class="required"><em>*</em>Zip/Postal Code</label>
                    <div class="input-box">
                        <?php
                        echo $form['post_code']->renderError();
                        echo $form['post_code']->render(array('class'=>'input-text required-entry'))?>

                    </div>
                </div>
            </li>
            <li class="fields address_change">
                <div class="field">
                    <label for="country" class="required"><em>*</em>Country</label>
                    <div class="input-box">
                        <?php
                        echo $form['country']->renderError();
                        echo $form['country']->render(array('class'=>'input-text required-entry'))?>
                    </div>
                </div>
            </li>
             
        </ul>
    </div>
    <div class="buttons-set">
        <p class="required">* Required Fields</p>
        <button type="submit" title="Save Address" class="button"><span><span>Save Address</span></span></button>
    </div>
    <?php
    echo $form->renderHiddenFields();
    echo $form->close();
    ?>
</div>